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BRN2023-00058 Expired - BRN Inspections - 4/3/2023
a w rI Mason County Mason County - Division of Community Development 615 W.Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov BRN2023-00058 BURN PERMIT PROJECT DESCRIPTION: BURN PERMIT ISSUED: 12/13/2023 SITE ADDRESS: 1111 E PICKERING RD SHELTON EXPIRES: 01/12/2024 PARCEL: 221337590011 APPLICANT: LIGHTBODY RICHARD E&MARY A OWNER: LIGHTBODY RICHARD E&MARY A 831 SE MILL CREEK RD 831 SE MILL CREEK RD SHELTON,WA 98584 SHELTON,WA 98584 CONTACT: SPENCER LAKE R.V. PARK 1111 E PICKERING RD SHELTON SHELTON,WA 98584 360-426-3178 FEES: Paid Due Burn Permit Fee $175.00 $0.00 Totals : $175.00 $0.00 REQUIRED INSPECTIONS Burn Inspection CONDITIONS * A responsible adult and equipment shall be on site and in attendance at the fire while burning. Must provide 24 hour fire watch. • Each pile must be at least one hundred (100)feet from any structure and at lease fifty(50)feet from standing timber. • After the burn is complete make sure the fire has not burned into the earth by checking the fire location for hot spots. * APPLICANT'S MUST CALL 360.426.4441 EACH DAY TO REPORT BURNING ACTIVITY. * Valid permit MUST be onsite while burning. If permit is not on site during burning the fire will be extinguished at your cost * The fire must not create a nuisance from smoke, obscure visibility on public roads and highways, or endanger life and property. Printed by:Annie Wilson on:12/13/2023 11:34 AM Page 1 of 2 � Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncoun"a.gov BURN PERMIT BRN2023-00058 * The following materials are prohibited and must not be burned: garbage, dead animals, asphalt, petroleum products, paints, rubber products, plastics, paper, cardboard, treated wood, construction/demolition debris, metal or any substance (other than natural vegetation)that releases toxic emissions, dense smoke, or obnoxious odors when burned. * All materials must originate from the property on which the burning is to occur. * Upon completion of above conditions, applicant must have inspection&approval before ignition. Call (360)427-9670, ext. 262 * *IF BURNING WITHOUT CALLING IN, THE FIRE WILL BE EXTINGUISHED AT OWNERS EXPENSE AND POSSIBLE SUSPENTION OF PERMIT.* * A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void. After a burn ban. has been implemented, all fires must be extinguished immediately. * Do not burn if wind is blowing more than seven (7)miles per hour. DO NOT BURN IF WIND BLOWING FROM * Fan required. * Access must be passable with 2 wheel drive vehicle. * Fire must be completely extinguished within three (3)days after ignition. * Maximum pile size is twenty(20)feet in diameter, a minimum ten (10)feet firebreak must be constructed around each pile. * Provide EXCAVATOR/DOZER (with fire extinguisher)on site with qualified operator. * On Site Water is required for permits between April 15th and Oct. 15th. A pump truck or trailer with 300 gallons of water loaded and 200 ft of hose. (The pump must be capable of pumping 20 gallons per minute through a one inch (diameter)50 foot section of hose.) * Permit includes two(2)inspections maximum, additional inspections will require a re-inspection fee. (at current rate). I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or the performance of construction. Issued By: i Contractor or Authorized Agent: Date: Printed by:Annie Wilson on:12/13/2023 11:34 AM Page 2 of 2 EXPIRATION DATE: I I all" Permit#: BRN - ©C050 MASON COUNTY BURN PERMIT APPLICATION 615 W Alder St• Shelton,WA 98584 SHELTON 360.427.9670 x352 9 BELFAIR 360.275.4467 x352 9 ELMA 360.482.5269 x352 APPLICANT/OWNER INFORMATION: CONTRACTOR INFORMATION: Owner spencer Lake RV Perk Owner _ Mailing Address 1111 E Pickering Rd Mailing Address City sheiton State WA Zip 98584 City State Zip _ Phone 3WA26-3178 Cell Phone nia Phone Other Phone Lien/Title Holder Mary A LlgMbody Contractor Reg.# Exp. E-mail address spencedakerv@gmail.com E-mail address Drivers Lic.#189TDC43B -D.O.B.or.14.39 Drivers Lic.# D.O.B. TAX PARCEL NUMBERS 22133-75-90011, 13, 200,350 (12 digit number) Fire District 5 SITE ADDRESS(please include street name, number&city)11I I E Pickering Rd.,Shelton,WA 98584 Directions(to the site)Highway 3 to Pickering Rd., Right at Pickering Rd. Park is located across from Grill. BURNING IS AUTHORIZED SUBJECT TO THE FOLLOWING CONDITIONS: • Valid permit MUST be onsite while burning.If permit is not on site duringburning urning the fire will be extinguished at your cost. • The following materials are prohibited and must not be burned: garbage, dead animals, asphalt, petroleum products, paints, rubber products, plastics, paper, cardboard, treated wood, construction/demolition debris, metal or any substance (other than natural vegetation)that releases toxic emissions,dense smoke,or obnoxious odors when burned. • All materials must originate from the property on which the burning is to occur. • The fire must not create a nuisance from smoke,obscure visibility on public roads and highways,or endanger life and property. • Maximum pile size is twenty(20)feet in diameter,a minimum ten(10)feet firebreak must be constructed around each pile. • Each pile must be at least one hundred(100)feet from any structure and at lease fifty(50)feet from standing timber. • Do not burn if wind is blowing more than seven(7)miles per hour.DO NOT BURN IF WIND BLOWING FROM • A responsible adult and equipment shall be on site and in attendance at the fire while burning.Must arovide 24 hour fire watch. • On Site Water is required for permits between April 15"and Oct. 15`h.A pump truck or trailer with 300 gallons of water loaded and 200 ft of hose.(The pump must be capable of pumping 20 gallons per minute through a one inch(diameter)50 foot section of hose.) • Provide EXCAVATOR/DOZER(with fire extinguisher)on site with qualified operator. • Fire must be completely extinguished within three(3)days after ignition. • Fan required. • Upon completion of above conditions,applicant must have inspection&approval before ignition.Call (360)427-9670,ext.262 • APPLICANT'S MUST CALL 360.426.4441 EACH DAY TO REPORT BURNING ACTIVITY. • APPLICANTS MUST CALL 360.539.7610(ORCCA) EACH DAY TO REPORT/REQUEST ANY AIR QUALITY ISSUES ASSOCIATED WITH BURNING. ************IF BURNING WITHOUT CALLING IN THE FIRE WILL BE EXTINGUISHED AT OWNERS EXPENSE AND POSSIBLE SUSPENTION OF PERMIT.*************** • After the burn is complete make sure the fire has not burned into the earth by checking the fire location for hot spots. • It is advisable to pump the entire content of the water tank onto the burn site to assure the fire is completely extinguished. The permitted individual is responsible for any rekindling on the fire/bum site. • A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void.After a burn ban has been implemented,all fires must be extinguished immediately. • Permit includes two(2)inspections maximum,additional inspections will require a re-inspection fee. (at current rate) • Access must be passable with 2 wheel drive vehicle Date Received. Application continued, please go to next page b Rev.Aor 19.2017 By Permit # PARCEL AND SITE INFORMATION: Parcel within 200'of. Saltwater❑ Lake❑ River/Creek/Stream o Pond❑ Wetlands❑ Seasonal Runoff❑ Yes/Qone Slopes or Bluffs> 15% Yes o Will timber be cut and sold in parcel preparation?Yes/ o Does Site require FPA or 6 yr.Moratorium: Yes/No Is site being converted or replanted:Yes/No Is site located in an Urban Growth Area(UGA)?:Yes/ o Unknown (Burning is currently NOT allowed inside UGAI Summarize proposed land clearing items to be burned: La f�I d� CGt p�GT 6 yt /,t Q SITE PLAN (to be verified and approved by Planner) In the space provided below,please draw a top-view site plan of the parcel and notate locations of the following items with distances to/from"Burn Pile": o Burn Pile and Feeder Piles o Any existing buildings/structures(ie:Residence, Garage, Storage shed, Driveway,etc.) o Existing standing timber o Any"Critical Areas" such as Steep Slopes, Lake, River/Creek, Wetlands, Seasonal Runoff, Streams, etc ---- - - - -- - - - - - - - - - - - - - - - - - - - - -- - -- - - - - - -- - - - - - -- -- - - - - - - - -- -- - - - - - - - -- - - - -- 5ne e� OWNER/CONTRACTOR: Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.The owner represents that the information provided is accurate and grants employees of Mason County&local fire authorities access to the above described property and structure for review and inspection.The person in charge of the fire will be liable for the cost of suppression if the fire gets out of control or if becomes necessary to extinguish the fire as the result of an enforcement action. X e ,Y442gn/=4May 24, 2023 SIGNA RE-MUST BE kNED By PROPE OWNER Date Signed FOR OFFICIAL USE ONLY: PLANNING DEPT REVIEW: Approved by&date: Denied by&date: a f f,00 yp.. ' � � z213�•75• QOOt3 6 hprr ° XI ft ,!! � •�° �b30�lcr�� Xk4Pic Kf i ,t�' k.OA ice' 615 W.Elder St.Bldg 8,SHELTON,WA 98584 MASON COUIS Z`y SHELTON:360-427-9670,EXT 352 COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 352 Ll J 1_i ,V� ELMA:360-482-5269,EXT 352 ff Buildrs%Plammig:Enviro mental HeWth,<—mvinity Health vAm.co.mason.wa.us BURN PERMIT BRN2023-00058 Issued Date 1 211 3/20 2 3 Expiration Date 01/12/2024 Parcel Number 221337590011 Fire District 5 Site Address 1111 E Pickering Rd Applicant LIGHTBODY RICHARD E&MARY A Contractor License Number Contractor Ex ration Date Phone p 1.Valid permit MUST be onsite while burning. If permit is not on site during burning the fire will be extinguished at your cost. 2.The following materials are prohibited and must not be burned:garbage, dead animals, asphalt, petroleum products, paints, rubber products, plastics, paper,cardboard;treated wood, construction,/demolition d3bris, metal or any substance (other than natural vegetation)that releases toxic emissions,dense smoke, or obnoxious odors when burned. 3.All materials must originate from the property on which the burning is to occur. 4.The fire must not create a nuisance from smoke, obscure visibility on public roads and highways,or endanger life and property. 5. Maximum pile size is twenty(20)teet in diameter, a minimum ter,(10)feet firebreak must be constructed around each pile. 6. Each pile must be at least one hundred('WO)feet from any structure and at lease fifty(50)feet from standing timber. 7. Do not burn if wind is blowing more than seven()^dies per hour. DO NOT BURN IF WIND BLOWING FROM 8.A responsible adult and equipment shall be on site and in attendance at the fire while burning. Must provide 24 hour fire watch. 9. On Site Water is required for permits between April 15th and Oct. 15th,A pump truck or trailer with 300 gallons of water loaded and 200 ft of hose. (The pump must be capable of pumping 20 gallons per minute through a one inch (diameter)50 foot section of hose.) 10. Provide EXCAVATOR/DOZER(with fire extinguisher)on site with qualified operator. 11. Fire must be completely extinguished within three(3)days after ignition 12. Fan required. 13. Upon completion of above conditions, applicant must have inset-clion&approval before ignition. Call (360)427-9670, ext. 352 14.APPLICANT'S MUST CALL 360.426-4441, EACH DAY TO REPORT BURNING ACTIVITY. 15.APPLICANTS MUST CALL 360,539.7610(ORCCA) EACH DAY TO REPORT/REQUEST ANY AIR QUALITY ISSUES ASSOCIATED WITH BURNING. 16.IF BURNING WITHOUT CALLING IN,THE FIRE WILL BE EXTINGUISHED AT OWNERS EXPENSE AND POSSIBLE SUSPENSION OF PERMIT. 17,After the burn is complete make sure the fire has not burned into the earth by checking the fire location for hot spots. 18. It is advisable to pump the entire content of the water tank onto the burn site to assure the fire is completely extinguished. The permitted individual is responsible for any rekindling on the fire/burn site. 19,A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void.After a bum ban has been implemented, all fires must be extinguished immediately. 20. Permit includes two(2)inspections maximum, additional inspections will require a re-inspection fee. (at current rate) 21.Access must be passable with 2 wheel drive vehicle Official Use Only Inspector: Sketch of Site/Comments: Date: